The bleeding heart: A case of cardiac angiosarcoma presenting with pulmonary hemorrhage and hemoptysis

Abstract

Primary cardiac angiosarcoma is an extremely rare and aggressive tumor that originates from the endothelial lining of cardiac blood vessels. We report a case of a 48-year-old man with history of military burn pit exposure, who presented with shortness of breath, cough, and hemoptysis. He was treated as a case of pneumonia, later he developed a diffuse pulmonary hemorrhage, and the etiology of his symptoms was found to be cardiac angiosarcoma with lung involvement. This case highlights the important clinical, radiological, and pathological characteristics of a rare cancer that commonly spreads to the lungs, urging healthcare providers to keep it in mind when diagnosing hemoptysis and pulmonary hemorrhage.

Keywords: Angiosarcoma; Cardiac angiosarcoma; Heart; Hemoptysis; Pulmonary hemorrhage; Sarcoma.

Fig. 1

Axial contrast-enhanced CT chest showing a 6.6 × 6.3 cm irregular, heterogeneously enhancing, hypodense mass (white arrow) arising from the right atrial appendage. Moderate right pleural effusion is also noted (red arrow).

Fig. 2

12-lead ECG on admission showing sinus tachycardia at 110 bpm with no ST-segment changes or arrhythmias.

Fig. 3

(A) Axial CT chest with contrast showing bilateral dense ground-glass opacities in upper and lower lobes, consistent with diffuse pulmonary hemorrhage (arrow). (B) The right atrial mass shows heterogeneous enhancement and is isoattenuating to the blood pool (arrow).

Fig. 4

Coronal contrast-enhanced CT chest: (A) Large heterogeneously enhancing mass (7.6 × 6.8 cm) originating from the right atrial wall and extending along the right heart border. A 3.1 cm pleural metastasis is noted anterior to the right upper lobe. (B) Enhancing anterior right basilar pleural lesion (4.5 cm) with interval reduction in right pleural effusion and improvement in pulmonary ground-glass opacities.